Other Possible Disorders
In addition, it's imperative that you find out if your child has ODD or another disorder so that you can undertake appropriate treatments and better understand your child. There are other disorders that your child could have or develop that could look like ODD, and there's a lot of overlap among some of these disorders.
Conduct disorder (CD), is another “externalizing” disorder that affects approximately 2 percent of girls and 9 percent of boys. Conduct disorder is considered more extreme than ODD, and what looks like ODD at first can develop into CD over time if it goes untreated. Your child cannot have ODD and CD at the same time — if your child meets the criteria for both disorders, she probably has CD. There are four sets of diagnostic criteria for CD in the DSM-IV:
Aggression to people and animals (like bullying, cruelty, use of weapons, rape, or assault)
Destruction of property (including destruction by setting fires)
Deceitfulness or theft (like shoplifting, breaking and entering, forgery, or conning people)
Serious violations of rules (like running away, truancy, staying out late against the rules before age thirteen)
At least three of these criteria must be met within the past year, and at least one of them must be met in the last six months for a diagnosis of CD. Conduct disorder can be mild, moderate, or severe, and can develop at any time in childhood.
One of the most famous childhood disorders is attention-deficit/hyperactivity disorder (ADHD). Your child can have ADHD and ODD at the same time. In fact, it's quite common to find these two disorders together: about half of kids with ADHD also have ODD. Kids with ADHD are described as having trouble staying on task, paying attention, waiting in line, following through after being given instructions, sitting still, and ignoring distractions. Not surprisingly, ADHD can be a huge obstacle to classroom learning if it's not treated effectively.
What's the difference between ADHD and ADD?
Attention deficit disorder, or ADD, is not listed as a separate diagnosis in the DSM-IV. When kids present with criteria for ADHD but the hyperactivity behaviors, like trouble sitting still, are less significant, it can fall under a subtype of ADHD called “predominantly inattentive.” Lay people often call this ADD.
Though parents hesitate at the idea of giving their children medications for mental health disorders, ADHD usually responds well to medication — much better than ODD does. If your child has ADHD and ODD, you may wish to talk seriously with a child psychiatrist about pharmacological treatment for ADHD to reduce the number of behavioral issues you're trying to address through parenting strategies.
ODD also commonly occurs in kids who have mood disorders, like bipolar disorder and depression. Bipolar disorder has also been more widely recognized by the public in recent years, though it has been effectively diagnosed for a long time. A few generations ago, it was generally called “manic depression,” and is characterized by extreme mood swings in which the person fluctuates from extreme elation to despair, though some people with bipolar disorder have small highs and much more extreme lows. People with bipolar disorder can be impulsive and reckless during the “highs,” spending beyond their limits and entertaining delusions of grandeur; during “lows” they may become melancholy and even catatonic or suicidal. Bipolar disorder can be hereditary, affecting several people in one family, but it can also present in a child whose family does not have any history of the disorder. It responds well to medication, but usually can't be “cured.” It is tricky to diagnose and many bipolar kids are misdiagnosed with CD, so if you suspect one of those two disorders, it's very important you have a psychologist or psychiatrist who specializes in children take a close look.
Co-occurring, often intertwined disorders are called “comorbidities” and are extremely common. Vicious cycles of comorbidities like depression, anxiety, and alcoholism are difficult to treat and impact almost every aspect of a patient's life, as well as family function.
Depression is another disorder that often goes hand-in-hand with ODD. As human beings, children are capable of the full adult spectrum of human emotion, meaning they experience profound sadness after a loss, or ennui from time to time. However, it also means they can become depressed, and are unlikely to “just snap out of it.”
People have a tendency to think children are like rubber — whatever happens to them just bounces off and they are okay. That's a simplification of child development that dangerously underestimates how children are affected by their environment. The truth is that kids are more like sponges than rubber, absorbing everything that happens to them. They may appear unaffected by loss (whether it's a death or other loss, like loss of a friend after a move) because they don't remember events the way adults do, or don't have the verbal skills to articulate their memories, but they still have feelings.
Depression in kids can look more like irritability than constant sadness. It's also characterized by a loss of interest in activities that used to be pleasurable, by feeling “blah,” and by changes in appetite or sleep patterns. Depression can affect a person's ability to think and make decisions.